NSG 526: Clinical Modalities in Advanced Psychiatric Mental
Health Nursing — Exam 2 | Practice Questions with Correct
Answers and Detail Rationales.
Question 1. A patient with major depressive disorder reports persistent
sadness, loss of interest, fatigue, poor concentration, feelings of worthlessness,
and recurrent thoughts of death. Which assessment should the psychiatric
mental health nurse practitioner prioritize?
A. Dietary preferences
B. Suicide risk, including intent, plan, means, and protective factors
C. Childhood academic performance
D. Preferred recreational activities
Correct Answer: B. Suicide risk, including intent, plan, means, and
protective factors
Rationale: Recurrent thoughts of death require direct and comprehensive
suicide-risk assessment. The clinician should determine whether thoughts are
passive or active and assess intent, planning, access to means, previous
attempts, substance use, agitation, protective factors, and the patient's ability
to maintain safety.
Question 2. A patient reports, “I feel depressed because I lost my job, but I
still enjoy spending time with my children and expect things to improve.”
Which finding would most strongly suggest that the clinician should further
evaluate whether the symptoms meet criteria for a major depressive episode?
A. Recent unemployment
B. Preserved ability to experience pleasure
C. Financial stress
D. Temporary sadness
Correct Answer: B. Preserved ability to experience pleasure
Rationale: Major depressive episodes involve a clinically significant cluster of
symptoms, with depressed mood and/or markedly diminished interest or
pleasure being central features. Preserved enjoyment does not exclude
1
,depression, but the clinician should assess the full symptom pattern, duration,
severity, impairment, and differential diagnoses rather than diagnosing solely
from sadness after a stressor.
Question 3. A patient with bipolar disorder presents with decreased need for
sleep, pressured speech, grandiosity, racing thoughts, excessive spending, and
severe occupational impairment. Which clinical feature most strongly
supports a manic episode rather than hypomania?
A. Increased energy
B. Reduced need for sleep
C. Severe functional impairment
D. Elevated mood
Correct Answer: C. Severe functional impairment
Rationale: Mania is distinguished from hypomania by greater severity,
including marked functional impairment, hospitalization, or psychotic
features. Both states can include increased energy, reduced need for sleep,
pressured speech, and elevated or irritable mood.
Question 4. A patient experiencing mania says, “I have discovered a
mathematical formula that will solve every economic problem in the world,
and I need to invest my entire savings immediately.” Which symptom is most
evident?
A. Grandiosity
B. Anhedonia
C. Thought blocking
D. Depersonalization
Correct Answer: A. Grandiosity
Rationale: Grandiosity involves an inflated sense of one's importance,
abilities, knowledge, or power. During mania, grandiosity may contribute to
unrealistic plans, excessive risk-taking, and impaired judgment.
2
,Question 5. A patient with bipolar disorder has been sleeping only 2 hours
per night but reports feeling completely rested and increasingly productive.
Which finding is most characteristic of mania?
A. Fatigue despite prolonged sleep
B. Decreased need for sleep
C. Hypersomnolence
D. Sleep paralysis
Correct Answer: B. Decreased need for sleep
Rationale: Decreased need for sleep differs from insomnia. A person with
mania may sleep very little yet report feeling rested and energetic. This
symptom is strongly associated with manic states.
Question 6. A patient with depression reports sleeping 12 hours every night
but remains exhausted during the day. Which term best describes this sleep
disturbance?
A. Hypersomnia
B. Decreased need for sleep
C. Circadian inversion
D. Sleep paralysis
Correct Answer: A. Hypersomnia
Rationale: Hypersomnia refers to excessive sleep or excessive sleepiness. In
depression, increased sleep may occur alongside fatigue, low motivation, and
impaired functioning. This differs from mania, in which decreased sleep
occurs without the expected fatigue.
Question 7. A patient reports sudden episodes of intense fear accompanied
by palpitations, trembling, chest discomfort, dizziness, and fear of dying. The
episodes occur unexpectedly. Which diagnosis should be considered?
3
, A. Panic disorder
B. Generalized anxiety disorder
C. Specific phobia
D. Obsessive-compulsive disorder
Correct Answer: A. Panic disorder
Rationale: Panic attacks involve abrupt surges of intense fear or discomfort
accompanied by physical and cognitive symptoms. Panic disorder involves
recurrent unexpected attacks plus persistent concern or maladaptive
behavioral changes related to the attacks.
Question 8. A patient worries excessively about finances, health, family,
employment, and several other areas almost every day. The patient reports
muscle tension, irritability, fatigue, and difficulty controlling the worry. Which
disorder should be considered?
A. Generalized anxiety disorder
B. Panic disorder
C. Specific phobia
D. Acute stress disorder
Correct Answer: A. Generalized anxiety disorder
Rationale: Generalized anxiety disorder is characterized by excessive anxiety
and worry across multiple domains that is difficult to control and
accompanied by associated symptoms such as restlessness, fatigue,
concentration problems, irritability, muscle tension, or sleep disturbance.
Question 9. A patient experiences an intense fear of flying and consistently
avoids airplanes despite recognizing that the fear is excessive. Which
intervention is most consistent with evidence-based treatment?
A. Gradual exposure therapy
B. Psychoanalysis exclusively
C. Permanent avoidance of flying
D. Immediate hospitalization
4
Health Nursing — Exam 2 | Practice Questions with Correct
Answers and Detail Rationales.
Question 1. A patient with major depressive disorder reports persistent
sadness, loss of interest, fatigue, poor concentration, feelings of worthlessness,
and recurrent thoughts of death. Which assessment should the psychiatric
mental health nurse practitioner prioritize?
A. Dietary preferences
B. Suicide risk, including intent, plan, means, and protective factors
C. Childhood academic performance
D. Preferred recreational activities
Correct Answer: B. Suicide risk, including intent, plan, means, and
protective factors
Rationale: Recurrent thoughts of death require direct and comprehensive
suicide-risk assessment. The clinician should determine whether thoughts are
passive or active and assess intent, planning, access to means, previous
attempts, substance use, agitation, protective factors, and the patient's ability
to maintain safety.
Question 2. A patient reports, “I feel depressed because I lost my job, but I
still enjoy spending time with my children and expect things to improve.”
Which finding would most strongly suggest that the clinician should further
evaluate whether the symptoms meet criteria for a major depressive episode?
A. Recent unemployment
B. Preserved ability to experience pleasure
C. Financial stress
D. Temporary sadness
Correct Answer: B. Preserved ability to experience pleasure
Rationale: Major depressive episodes involve a clinically significant cluster of
symptoms, with depressed mood and/or markedly diminished interest or
pleasure being central features. Preserved enjoyment does not exclude
1
,depression, but the clinician should assess the full symptom pattern, duration,
severity, impairment, and differential diagnoses rather than diagnosing solely
from sadness after a stressor.
Question 3. A patient with bipolar disorder presents with decreased need for
sleep, pressured speech, grandiosity, racing thoughts, excessive spending, and
severe occupational impairment. Which clinical feature most strongly
supports a manic episode rather than hypomania?
A. Increased energy
B. Reduced need for sleep
C. Severe functional impairment
D. Elevated mood
Correct Answer: C. Severe functional impairment
Rationale: Mania is distinguished from hypomania by greater severity,
including marked functional impairment, hospitalization, or psychotic
features. Both states can include increased energy, reduced need for sleep,
pressured speech, and elevated or irritable mood.
Question 4. A patient experiencing mania says, “I have discovered a
mathematical formula that will solve every economic problem in the world,
and I need to invest my entire savings immediately.” Which symptom is most
evident?
A. Grandiosity
B. Anhedonia
C. Thought blocking
D. Depersonalization
Correct Answer: A. Grandiosity
Rationale: Grandiosity involves an inflated sense of one's importance,
abilities, knowledge, or power. During mania, grandiosity may contribute to
unrealistic plans, excessive risk-taking, and impaired judgment.
2
,Question 5. A patient with bipolar disorder has been sleeping only 2 hours
per night but reports feeling completely rested and increasingly productive.
Which finding is most characteristic of mania?
A. Fatigue despite prolonged sleep
B. Decreased need for sleep
C. Hypersomnolence
D. Sleep paralysis
Correct Answer: B. Decreased need for sleep
Rationale: Decreased need for sleep differs from insomnia. A person with
mania may sleep very little yet report feeling rested and energetic. This
symptom is strongly associated with manic states.
Question 6. A patient with depression reports sleeping 12 hours every night
but remains exhausted during the day. Which term best describes this sleep
disturbance?
A. Hypersomnia
B. Decreased need for sleep
C. Circadian inversion
D. Sleep paralysis
Correct Answer: A. Hypersomnia
Rationale: Hypersomnia refers to excessive sleep or excessive sleepiness. In
depression, increased sleep may occur alongside fatigue, low motivation, and
impaired functioning. This differs from mania, in which decreased sleep
occurs without the expected fatigue.
Question 7. A patient reports sudden episodes of intense fear accompanied
by palpitations, trembling, chest discomfort, dizziness, and fear of dying. The
episodes occur unexpectedly. Which diagnosis should be considered?
3
, A. Panic disorder
B. Generalized anxiety disorder
C. Specific phobia
D. Obsessive-compulsive disorder
Correct Answer: A. Panic disorder
Rationale: Panic attacks involve abrupt surges of intense fear or discomfort
accompanied by physical and cognitive symptoms. Panic disorder involves
recurrent unexpected attacks plus persistent concern or maladaptive
behavioral changes related to the attacks.
Question 8. A patient worries excessively about finances, health, family,
employment, and several other areas almost every day. The patient reports
muscle tension, irritability, fatigue, and difficulty controlling the worry. Which
disorder should be considered?
A. Generalized anxiety disorder
B. Panic disorder
C. Specific phobia
D. Acute stress disorder
Correct Answer: A. Generalized anxiety disorder
Rationale: Generalized anxiety disorder is characterized by excessive anxiety
and worry across multiple domains that is difficult to control and
accompanied by associated symptoms such as restlessness, fatigue,
concentration problems, irritability, muscle tension, or sleep disturbance.
Question 9. A patient experiences an intense fear of flying and consistently
avoids airplanes despite recognizing that the fear is excessive. Which
intervention is most consistent with evidence-based treatment?
A. Gradual exposure therapy
B. Psychoanalysis exclusively
C. Permanent avoidance of flying
D. Immediate hospitalization
4
